Provider Demographics
NPI:1235307182
Name:HORIZON DENTAL OF OREM LLC
Entity Type:Organization
Organization Name:HORIZON DENTAL OF OREM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KASE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-561-8490
Mailing Address - Street 1:1385 W 1600 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2431
Mailing Address - Country:US
Mailing Address - Phone:801-226-2655
Mailing Address - Fax:801-225-0627
Practice Address - Street 1:1385 W 1600 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2431
Practice Address - Country:US
Practice Address - Phone:801-226-2655
Practice Address - Fax:801-225-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty